| NPI | 1134687312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-03-07 |